Pediatric Corneal Collagen Cross-Linking: Long-Term Follow-Up of Visual, Refractive, and Topographic Outcomes

Purpose:To evaluate the long-term visual, refractive, and topographic outcomes of corneal collagen cross-linking (CXL) in the management of pediatric keratoconus.Methods:Forty eyes of 40 consecutive patients with progressive keratoconus aged below 19 years were enrolled in this prospective study. All patient eyes underwent CXL with the standard (Dresden) protocol. Uncorrected distance visual acuity, best spectacle-corrected distance visual acuity, manifest refraction, slit-lamp biomicroscopy, corneal topography, corneal aberrometry, and endothelial cell counts were evaluated at baseline and at all postoperative follow-up examinations until month 48.Results:Mean age of patients was 15.2 1.9 years (10-18 years). Follow-up was 4 years. The mean improvements in uncorrected distance visual acuity (from 0.9 +/- 0.3 logMAR to 0.5 +/- 0.3 logMAR) and best spectacle-corrected distance visual acuity (from 0.4 +/- 0.2 logMAR to 0.1 +/- 0.1 logMAR) were statistically significant at month 48 (P = 0.0001). The mean Kmax decreased from 58.4 +/- 5.5 D at baseline to 57.0 +/- 5.3 D at month 48 (P = 0.04). Significant improvements in topographic and elevation indices and corneal aberrations were also noted after postoperative month 6. There was no change in the mean endothelial cell density (P > 0.05), and there was no progression or sight-threatening complication in any patient eye.Conclusions:Corneal CXL seems to be safe and effective in halting the progression of keratoconus in pediatric patients at 4-year follow-up. In addition, the procedure provides improvements in visual, refractive, topographic, and corneal aberrometric measurements.